Working Boston's Flu Epidemic

Dr. Joshua Liao chronicles his story on the frontlines of the public health emergency.

Entering the hospital a few days ago, I could see the stress etched into my colleagues’ faces as I prepared to accept their patient lists and take over patient care responsibilities.

The first list I’m given is noticeably long. As my colleague and I review it, I notice complaints of cough littering the page. Flu, he says for the first patient. Got it, I reply. Another flu, he repeats; OK, I say, nodding briskly.

“Flu again,” he says for the fifth time, taking a second to pause and sigh. Six lists and 35 patients later, I sit quietly in disbelief because of all the patients in my care who have confirmed or suspected flu.

I admit two more people from the ER, one whose cough is concerning for flu and/or bacterial pneumonia. She has bad asthma and a history of respiratory infections, and after several days with sick children, she’s developed fever, difficulty breathing, and debilitating cough. Preliminary tests are pending, but I place her in an isolated room and start antibiotics and the anti-flu medication Tamiflu.

Upstairs in a workroom, a senior overnight physician scrolls the electronic health record, reviewing cases being seen in the emergency room. “Look at this,” he says, “fourteen complaints of cough listed in a teeming full emergency room. Yikes.”

“Isn’t that normal this time of year though?”

“Not quite like this.” His voice trails off as his eyes search the screen. “Not quite like this . . .”

I sign into a computer and find electronic messages from two clinic patients. One deferred the vaccine earlier in the year but is now concerned with the recent news coverage. The other has developed concerning symptoms she wants to discuss. I begin replying but am interrupted by two new admissions, both suspected cases of flu.

The emergency department is so full that the waiting room, which is normally outfitted with chairs for friends and family members, has been converted into an extra patient holding area. The makeshift space is crawling with activity. The once open area is now partitioned by drapes into thin lanes, each only wide enough to accommodate a gurney and standing room for one person. Extra beds line the hallways.

While transport service workers zigzag through the crowded space with patients in wheelchairs, I track down my patient’s nurse, who has been darting around caring for patients in different holding areas. She apologizes profusely after handing me a blood consent form for the wrong patient.

As I spend the night caring for flu patients, I do not know that tomorrow the city will declare a public health emergency and that Google’s trend will continue spiking to unprecedented levels. Instead, I am repeatedly struck by the diversity of patients flu is affecting this year, and the range of disease severity it causes.

Here are my recommendations to protect yourself and those around you:

Get vaccinated: Three of the worst circulating misconceptions are that the vaccine doesn’t help (the vaccine is effective and has likely prevented an even wider spread of illness), that it’s a disease of the elderly (many affected people are young), and that it’s too late to get one now if you passed on it earlier in the year (it’s never too late).

If you develop symptoms, contact your primary care doctor: There are different manifestations and severities to flu, and illness frequently doesn’t require a trip to the ER or hospital. If you notice flu symptoms, an effective first step is to contact your primary care doctor, who can help differentiate serious from mild symptoms and possibly initiate outpatient treatment.